Malaria

Question 1

What is used for acute uncomplicated falciparum malaria?

Answer 1

Artemether with lumefantrine

Atovaquone with proguanil

Question 2

What is used for the prophylaxis of falciparum malaria?

Answer 2

Atovaquone with proguanil

Question 3

What is used for the treatment of non-falciparum malaria?

Answer 3

Chloroquine

Question 4

If the infective species is not known or if the infection is mixed, what is, and what is not, a suitable anti-malarial?

Answer 4

Chloroquine is not suitable.

Quinine is suitable. Atovaquone with proguanil hydrochloride is suitable. Artemether with lumefantrine is suitable.

Question 5

In what ages can doxycycline be used for the prophylaxis of malaria in areas of chloroquine resistance?

Answer 5

12+

Question 6

What medicines can be used for the prophylaxis of malaria in areas of chloroquine resistance?

Answer 6

Doxycycline and mefloquine and atovaquone with proguanil

Question 7

What anti-malarials are not suitable for the treatment of falciparum malaria owing to resistance?

Answer 7

Mefloquine and chloroquine

Question 8

What insect repellent is effective against bites?

Answer 8

Diethyltoluamide (20-50%)

Question 9

Diethyltoluamide (DEET) can be used in which groups of people?

Answer 9

Over 2 months of age, pregnant, and breastfeeding.

Advise breastfeeding mothers to wash their hands and breast tissue before handling infants.

Question 10

What advice can be given to people using diethyltoluamide?

Answer 10

Apply DEET after sunscreen as DEET reduces the SPF of sunscreen. SPF 30-50 should be applied.

Question 11

What is the length of prophylaxis for chloroquine? (short-term)

Answer 11

1 week before travel and for 4 weeks after leaving the area.

Question 12

What is the length of prophylaxis for proguanil hydrochloride? (short-term)

Answer 12

1 week before travel and for 4 weeks after leaving the area.

Question 13

What is the length of prophylaxis for mefloquine? (short-term)

Answer 13

2-3 weeks before travel and up to 4 weeks after leaving the area.

Question 14

What is the length of prophylaxis for atovaquone with proguanil hydrochloride? (short-term)

Answer 14

1-2 days before travel and up to 1 week after leaving the area.

Question 15

What is the length of long-term prophylaxis for mefloquine?

Answer 15

1 year

Question 16

What is the length of long-term prophylaxis for doxycycline?

Answer 16

2 years

Question 17

What is the length of long-term prophylaxis for atovaquone with proguanil hydrochloride?

Answer 17

1 year

Question 18

After return from a malarial region, what length of time could a person still be at risk for malaria?

Answer 18

3 months to 1 year

Question 19

What anti-malarial medications are not suitable for people with epilepsy?

Answer 19

Chloroquine and mefloquine

Question 20

What anti-malarial medications are suitable for people with epilepsy?

Answer 20

Doxycycline or atovaquone with proguanil

Question 21

Which individuals are at particular risk of malaria?

Answer 21

Asplenic individuals or those with severe splenic dysfunction

Question 22

Which anti-malarials can be given during pregnancy?

Answer 22

Chloroquine and proguanil hydrochloride

Mefloquine can also be used (caution in first trimester)

Question 23

What supplementation should be given to pregnant women who are taking proguanil hydrochloride?

Answer 23

Folic acid, for the length of time proguanil hydrochloride is used during pregnancy

Question 24

What anti-malarial is contra-indicated during pregnancy?

Answer 24

Doxycycline as it affects teeth and skeletal development

Question 25

What special precautions should be taken for people taking warfarin sodium travelling to a malarial region?

Answer 25

Must have chemoprophylaxis 2-3 weeks before departure and must ensure stable INR before departure. Measure INR before chemoprophylaxis, 7 days after starting, and upon return.

Question 26

When should emergency standby treatment be given to a person and what should be provided?

Answer 26

No access to medical care. Provide written instructions to seek urgent medical attention if fever develops 7 days or more after arriving in an area with a high risk of malaria and how to administer emergency treatment.

Question 27

What advice can be given to settled immigrants in the UK who have arrived from abroad (in relation to malaria)?

Answer 27

Immunity is lost rapidly, and an area that was previously non-malarious can become malarious.

Question 28

How do you treat falciparum malaria?

Answer 28

Oral quinine by mouth for 5-7 days together with or followed by doxycycline for 7 days. Alternatively, Malarone (atovaquone with proguanil) or Riamet (artemether with lumefantrine).

Question 29

How is falciparum malaria treated in pregnancy?

Answer 29

Oral and intravenous quinine (adult dose).

Question 30

How do you treat non-falciparum malaria caused by P. Malariae and P. knowlesi?

Answer 30

Chloroquine

Question 31

How do you treat non-falciparum malaria caused by P. vivax and P. ovale?

Answer 31

Primaquine [unlicensed] after chloroquine

Question 32

How do you treat P. vivax or P. ovale in pregnancy?

Answer 32

Postpone use of primaquine until pregnancy is over, and continue with chloroquine, given weekly.

Question 33

How do you minimise the risk of ocular toxicity when giving chloroquine?

Answer 33

Do not exceed 4 mg/kg daily (equivalent to chloroquine base 2.5 mg/kg daily)

Question 34

What are special cautions to bear in mind with mefloquine?

Answer 34

It is associated with serious neuropsychiatric reactions (abnormal dreams, anxiety, depression). May persist for several months due to its long half life.

Question 35

What are special cautions to bear in mind with quinine?

Answer 35

It is associated with dose-dependent QT-interval-prolonging effects. Use in caution in patients with atrioventricular block or risk factors for QT prolongation.

Question 36

How do you treat chronic hepatitis B?

Answer 36

Peginterferon alfa, a response should be achieved in 4 months. Alternatives are entecavir or tenofovir disoproxil, a response should be achieved within 6-9 months. Adefovir dipivoxil, lamivudine, or telbivudine are other options. If no response in those time spans then discontinue.

Question 37

How do you treat chronic hepatitis B and HIV together?

Answer 37

Tenofovir disoproxil is one option. Another is tenofovir disoproxil with either emticritabine or lamivudine.

Question 38

What are special warnings to bear in mind with the use of direct-acting anti-virals?

Answer 38

They may affect the efficacy of vitamin K antagonists therefore INR should be monitored closely. Hepatitis B re-activation is possible in patients co-infected with hepatitis B and C when using direct-acting antiviral interferon-free regimens. Rapid reduction in hepatitis C viral load may affect glucose metabolism in patients with diabetes and result in hypoglycaemia therefore monitor glucose levels within the first 3 months of treatment.

Question 39

How do you treat mild chronic hepatitis C?

Answer 39

With peginterferon alfa and ribarivin (OR) Ledipasvir with sofosbuvir (OR) Sofosbuvir with peginterferon alfa and ribavirin (genotype 1, genotype 3 with cirrhosis, genotype 3 that has not adequately responded to interferon-based treatment, genotype 4, 5, or 6 with cirrhosis).

Question 40

When treating chronic hepatitis C in patients with cirrhosis, what conditions should be met?

Answer 40

Child-Pugh class A, platelet count of 75kmm or more, no features of portal hypertension, no history of an HCV associated decompensation, and not previously treated with an NS5A inhibitor